A LOOK INTO GLOBAL HEALTH IN THE MIDST OF THE GLOBAL REFUGEE CRISIS

In the context of healthcare, immigrants have long been thought to generally be healthier than their native born counterparts. However, much of the research done on this topic fails to differentiate forced migrants — refugees — from immigrants. Refugees in various parts of the world, of all ethnic backgrounds, have demonstrated a unique set of health needs that should be addressed in order to ensure the utmost care. From Rohingya refugees in Bangladesh to Palestinian refugees in Jordan, Lebanon, and Syria and even asylum seekers in Canada and the U.S, these populations share intense trauma and substandard living environments which contribute to the health problems they face.For the Rohingya population, a minority group indigenous to Myanmar described by the United Nations as “one of the most persecuted minorities in the world”, water-borne disease outbreaks such as cholera, bloody diarrhea, typhoid, and hepatitis E have been a major concern in the refugee camps established in Bangladesh. Additionally, 412 suspected measles cases were reported in November 2017, with 82% of cases occurring in children under 5 years of age. One of the most pressing issues the Rohingya face is lack of proper vaccination. Nearly 45% of children under 15 years of age have not been vaccinated but >95% coverage is required for herd immunity, proving that the vaccination campaign must be continued and expanded. In addition to these gaps in the healthcare provided for the Rohingya, gender-based violence has been overtly prevalent and has shown obvious correlations to adverse health outcomes faced by Rohingya women. Several cases of sexual violence against Rohingya women at the hands of Myanmar military professionals have been described to healthcare providers stationed in camps in Bangladesh. It has been reported that one in seven Rohingya women had undergone at least one unskilled abortion under unhygienic conditions. Thus, the female asylum seekers have presented with various gynecological and obstetrics needs such as fistulas, miscarriages, preterm births, and more. Additionally, the World Health Organization (WHO) has emphasized that the management of sexually transmitted diseases (STD) and HIV/AIDs are essential to address the needs of populations living in camp settlements. A recent study in Ontario, Canada has highlighted that overall refugee status, not particular to any one ethnic group, was associated with several adverse maternal and perinatal health outcomes, but the associations were particularly strong for HIV. Thus, HIV/AIDs are particularly high frequency and high-risk hazards amongst the global refugee population. Children in particular are also a subset of the refugee population facing unique health issues which should be outlined, assessed, and communicated to the greater healthcare community. For instance, amongst the Palestinian refugee population, there is a severe deficiency of services for child protection, mental health and child disability. There is also a shortage of specialized medical staff in family practice (particularly with an orientation to children), neurology, pediatric surgery and psychiatry. This is particularly damaging as 40% of this refugee population is under 18 years, and the population growth rate is extremely high at over 3%. This subset of underage Palestinian refugees have shown to have immense mental health afflictions. A study in 2003 found that 93% of children had experienced being or feeling threatened, a loss or a lack of security, and fear. Parents also reported many psychological symptoms in their children such as nightmares, enuresis, and high levels of aggressive behaviors, hyperactivity, low attention and concentration. A survey of Palestinian adolescents in school investigated collective and individual exposures to violence and its negative effect on adolescents’ mental health. The level of exposure to trauma and violence was very high. “The experience of the teenagers was horrific: 80% had seen shootings, 28% had seen a stranger killed, 11% had seen a friend or neighbor killed and 54% of boys had experienced body searches. Not surprisingly, 10.4% of the participants had a depressive-like state, 14.1% emotional difficulties and 10.3% somatic disorders”. According to Defense for Children International, between 500 and 700 Palestinian children are detained and prosecuted every year by Israeli security forces, usually for stone throwing. During 2016, the monthly average of children between 12 and 17 held in detention was 375, the highest figure in the last decade.The health adversities faced by refugee women and children, in particular, peaked my interest because I saw so much similarity between the reports of the Rohingya and Palestinian populations and the studies I am on here at Empower, specifically, the “Telomeres, Epigenetics, and Trauma (TET)” study. Our research on TET involves looking at the correlation between women who have experience sexual trauma and advanced aging by means of shortened telomeres (which has implications for various ailments such as cancer). Another facet of our study looks at transgenerational biomarkers of advanced aging in the children of the women who have experienced sexual trauma. Many of these children have presented with developmental delays so we seek to see if the trauma their mothers faced led to epigenetic changes contributing to their health outcomes. The main concept we are exploring in this phase of our study, the relationship between a mother’s trauma and her children’s health, is one which I believe is integral when looking at refugee health, as well. Gender-based violence is omnipresent in refugee populations in addition to other forms of trauma leading to mental health complications and potentially advanced aging. If this is the case, the subset of refugees who are traumatized mothers may have children whose health can be at risk due to epigenetic changes rooting from their mother’s trauma. Thus, the violence and horrid experiences refugees live through daily have the potential for having an adverse health effect on generations to come, even if following generations do not live in the same situations as their ancestors. Pondering on this connection between the research I am a part of at Empower and the greater global refugee crisis helped narrow my perspective when thinking about refugee health. The health needs of refugees stem from issues that are not vast problems that have no hope to solved. Instead, these health issues are being researched and can be tackled with greater attention from the international healthcare community. In fact, these health issues are prevalent in the microcosm of refugees/asylum seekers in New York City. At the EMPOWER Clinic at Gouverneur health —one of the few clinics designed to meet the medical and mental health needs of survivors of sex trafficking and sexual violence — run by our lab Principal Investigator, Dr. Ades, all of the patients have experience gender-based violence and sexual trauma. At this clinic alone, Dr. Ades has written 80 affidavits for patients seeking asylum in the United States. Implying that the issue of gender-based violence against refugees is immensely relevant even in our own home city. The unique health needs that refugees all over the world present with are for the most part related to the trauma they have undergone while resetting. It is easy to write off their health issues as an unfortunate accompaniment to the difficult lives they live and to view these issues as large, global problems outside of the reach of our help. However, these issues are present even in our own city so change can start from here and eventually reach overseas. This is a very ideal way to look at this global crisis but all efforts can help create a change. This week at is NYU Refugee Week 2018, “a week long series of events, April 16th-20th, that aim to shed light on an on-going international phenomenon through various events surrounding the global refugee crisis.” By bringing this issue to light on campus, we can narrow the scope in which we view this seemingly boundless health crisis and help refugees receive the utmost healthcare.